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A civilian perspective on ballistic trauma and gunshot injuries

DOI: 10.1186/1757-7241-18-35

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A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.In contrast to a stagnating incidence of civilian gunshot wounds in the United States, gunshot violence shows different trends in European countries. Firearm associated crime was increasing up to 30% in the UK between 1998 and 2002 [1]. In the same period firearm associated crime in Germany was markedly decreasing. In 2007 in Germany only 4558 criminal acts with the use of firearms were registered [2]. Additionally, in high income countries a significant number of gunshot wounds are related to suicide attempts [3]. As seen in the United States, gunshot violence has bes

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